State targets delivery in NHI pilots

Baragwanath hospital in Johannesburg for NHI story by Slindile.photo by Simphiwe Mbokazi

The department of Health has put the testing of various proposals in the National Health Insurance (NHI) green paper on the back burner, saying its priority in the pilot phase is service delivery.

The spokesman for the health ministry, Joe Maila, said on Friday that the NHI was all about improving access to quality health-care services and that was where the department’s focus lay “at this stage”.

Health economists previously raised concerns that various proposals in the green paper should be tested, including the funding model of the NHI.

The funding model was seen as a key determinant as to whether the NHI would be a success story or another good government policy that failed because of poor implementation. However, Maila said that he believed the department was on course by testing only service delivery.

Last year, in his written response to DA questions, Health Minister Aaron Motsoaledi said the funding framework used for the financing of the NHI pilots was “neither intended to ensure that patients are not left with any out-of-pocket liabilities; nor to ensure that all providers, particularly district hospitals, are paid”.

In his State of the Nation address last week, President Jacob Zuma said an NHI fund would be set up in 2014, the year in which the insurance programme was planned to kick off nationally.

Cobus Venter, the chief economist at Stellenbosch Economics, said the pilot projects were at this stage aimed at indicating shortcomings of the NHI plan and where the greatest needs were.

When the results of the pilots were reported, they would not offer guidance on whether the plan would be a success or not on all aspects. However, it was a logical thing to do to worry about the next phase of the programme when the pilot phase was complete, he said.

“Funding at the moment can almost be put on the back burner. The Treasury has indicated significant money that will be spent on NHI,” he said.

He added that the focus on service delivery during the pilot phases was welcome.

Zuma said as from April, the first group of approximately 600 private medical practitioners would be contracted to provide medical services at 533 clinics in 10 NHI pilot districts.

The Department of Health would also work on accelerating and intensifying progress in the pilot districts.

Venter said contracting with private doctors was a sign of progress and would alleviate pressure on the public sector.

Maila said the process of contracting with the medical practitioners was still going on, but could not disclose the number of those already signed up. He said the department was confident that it would meet the target of 600 by April.

He said the doctors constituted only general practitioners who worked at district clinics on certain days for a specific number of hours while they ran their own practices.

Maila added that the Department of Health had already appointed different categories of specialists in each of the district offices where NHI pilots were taking place.

“We are learning out of it and we think we are on course. But there is always room for improvement. For instance, in particular districts we are not able to get certain specialists we want at that time,” said Maila.

The National Education, Health and Allied Workers Union (Nehawu) said it was pleased to learn about the creation of the NHI fund but was concerned about the sluggish approach in policy initiation on the part of government.

“There is a need to create certainty by making public the white paper as a policy framework, guarantee transparency, create clarity around the monitoring processes and consulting the relevant constituencies,” Nehawu said.

The Federation of Unions of SA said it supported the steady progress in testing the NHI.